The Shocking Future of Health Care

Jeffrey C. Bauer, PhD

Health care futurism did not exist as a recognized discipline when Future Shock first appeared in 1970. Scholarly interest in the evolution of the medical marketplace was in its infancy back then. To the limited extent that Americans thought about how illnesses would be treated in the future, their ideas were more likely shaped by Star Trek’s Dr. “Bones” McCoy than by intellectual thought leaders who had seriously contemplated the topic. Alvin Toffler was among the earliest commentators to lay out a reasoned, richly documented vision of coming changes in the science and technology of human health. Therefore, the 50th anniversary of his pioneering work is good reason to present a retrospective of what he got right and wrong and to use the historical lessons of his seminal work for improving how we look ahead to the next 50 years. (I was probably destined to write this piece. My career in health care started the year before Future Shock was published, and I experienced the subsequent five decades as a full-time industry insider.)

Several of Toffler’s health care predictions really missed the mark. It must fairly be noted that he was not alone in misreading the crystal ball. Lacking expertise in medical science, he accepted the prognostications of many leading researchers who grossly overestimated the long-term impact of their own work. In a section titled “The Predesigned Body,” for example, Toffler concluded that cloning and related genetic manipulations would be “producing [biological] spare parts for failing human bodies” in as little as 15 years—precisely in 1984, according to one expert he quoted. Under the heading “The Cyborg Among Us,” he incorrectly foresaw widespread integration of intelligent machines into human bodies at about the same time. He also wrongly projected that technologies “to create altogether new versions of man” would soon follow. Likewise, Toffler’s views on the future of health care did not anticipate strong economic forces that shaped the medical marketplace,¹ nor did he foresee ethical and political roadblocks that have significantly constrained change over the past 50 years.

On the other hand, Future Shock includes exceptional health-related insights that more than compensate for its failed predictions. The very concept of future shock accurately presaged a coming elaboration of medical science’s fundamental paradigm:

We may define future shock as the distress, both physical and psychological, that arises from an overload of the human organism’s physical adaptive systems and its decision-making processes. Put more simply, future shock is the human response to overstimulation. Different people react to future shock in different ways. Its symptoms also vary according to the stage and intensity of the disease. These symptoms range all the way from anxiety, hostility to helpful authority, and seemingly senseless violence, to physical illness, depression and apathy. (From Chapter 15: Future Shock: The Physical Dimension)

Alvin Toffler recognized the major role that environmental factors play in determining health—defined by the World Health Organization as an individual’s complete state of physical, mental, and social well-being (not just the absence of disease)—at a time when medical science was focused almost exclusively on curing diseases with surgery and drugs. He also anticipated how the mind-body link significantly determines individual and population health:

If future shock were a matter of physical illness alone, it might be easier to prevent and to treat. But future shock attacks the psyche as well. Just as the body cracks under the strain of environmental over-stimulation, the “mind” and its decision processes behave erratically when overloaded. By indiscriminately racing the engines of change, we may be undermining not merely the health of those least able to adapt, but their very ability to act rationally on their own behalf. (From Chapter 16, “Future Shock: The Psychological Dimension”)

Related criticism of psychoanalysis was equally prescient. With its multidimensional view of human health, Future Shock clearly described the increasingly complex path that medical science has ultimately followed. For this reason alone, it is sad that the book had little or no direct impact on health care delivery in the decades following publication. Rather than studying how knowledge of human health could be used to improve efficiency and effectiveness in the medical marketplace—a key focus of Toffler’s approach—pioneers in health policy concentrated almost exclusively on reducing expenditures on Medicare and Medicaid. Health reform experts have very little to show for all their work on cost-containment, so it’s worth pondering how much better off American health care would be today if they had adopted Toffler’s focus on health care delivery rather than health care finance.

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Toffler’s views on the future of health care did not anticipate strong economic forces that shaped the medical marketplace, nor did he foresee ethical and political roadblocks that have significantly constrained change over the past 50 years.

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Toffler’s general method for projecting the future of health care was qualitative. It distilled the thoughts of leading medical researchers into scenarios that could occur if the underlying forces (positive and negative) were properly addressed. Like other visionary thinkers, Toffler was captivated by the realm of possibilities. However, a quantitative approach to futurism was emerging at the same time. Social scientists shifted from intellectual (subjective) analysis to statistical (objective) analysis, claiming to improve the accuracy of their insights by studying data rather than exploring ideas. A book published in 1973 by the Club of Rome, The Limits to Growth, quickly attracted as much attention as Future Shock. Both works addressed many of the same issues, but Limits drew its conclusions from mathematical models.

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Health reform experts have very little to show for all their work on cost-containment, so it’s worth pondering how much better off American health care would be today if they had adopted Toffler’s focus on health care delivery rather than health care finance.

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Future Shock and The Limits to Growth were major topics of discussion while I was in graduate school, getting a Ph.D. in economics. I vividly remember creative tension between my “old school” professors (including Kenneth Boulding, prominently quoted in Future Shock), who specialized in traditional economic theory, and younger faculty members who taught math-based econometrics as the foundation of a “new and improved” social science.² Data-fueled analytics quickly took over the field of economics and has since predominated as its principal method for predicting the future. Economists generally let the numbers speak for themselves, with little attention to the validity (meaningfulness) and reliability (accuracy) of the underlying measurements.³ Toffler and his intellectual allies lost the methodological battle with the “quants,” but history suggests his tradition of qualitative analysis will ultimately win the war—especially given economists’ abysmal track record in making data-based predictions over the past 50 years.⁴

So, what picture of health care would Alvin Toffler see in his crystal ball if he were writing a 50th anniversary edition of Future Shock? He would surely continue to position genetics as a powerful force for progress, but at a much slower pace than he envisioned in 1970 because its study and subsequent applications and implications have become unexpectedly complex. Given Toffler’s pioneering insight into the mind-body connection, I think his future view today would still reflect medical care’s incipient evolution from acute care to chronic care—from curing diseases once they occur to managing them before they become debilitating. I also expect he would eloquently address the social determinants of health (e.g., malnutrition, obesity, inadequate physical activity, sleep deprivation, behavioral and mental problems, poor housing) and the societal consequences of failing to deal with them. I’m not sure how he would address government’s role in reforming health care, but recent experience would probably make him rather cynical.

Most importantly, I believe Alvin Toffler would recognize that today’s health care equivalent of future shock is climate change. He would use his skills in qualitative analysis to show how unprecedented changes in the weather will likely cause even more disease and social dysfunction than overstimulation from technological change. I can easily imagine him drawing well-documented, multidisciplinary parallels between climate change and the worst causes of death in human history. His updated edition might even be retitled Climate Catastrophe. I take absolutely no delight in concluding on this grim note, but I carefully studied Future Shock while earning a Ph.D. in the dismal science, and I was previously trained in climate science. From both these perspectives, I believe that Alvin Toffler’s way of looking at the future—if not all his predictions—is at least as important for population health today as it was 50 years ago.

Jeffrey C. Bauer, PhD, is an internationally recognized health futurist and medical economist. Author of nearly 300 publications on the medical marketplace, Dr. Bauer is a frequent keynote speaker to regional and national meetings about evolution of the medical marketplace; he focuses on private-sector solutions that increase efficiency and effectiveness of health care delivery. He spent 18 years as a medical school professor and administrator and has also served as a state governor’s health policy adviser, independent consultant, and vice president for health care forecasting and strategy at two Fortune 500 companies. Dr. Bauer was a Ford Foundation Independent Scholar, Fulbright Scholar, and Kellogg Foundation National Fellow. He lives in Madison, WI.

1. For in-depth analysis of medical monopoly and related economic problems, see Bauer, JC, Not What the Doctor Ordered: Liberating Caregivers and Empowering Consumers for Successful Health Reform, Third Edition (New York: Routledge, 2020).

2. For a detailed analysis of how I resolved the methodological conflict in my ensuing career as a health futurist, see Bauer, JC, Upgrading Leadership’s Crystal Ball: Five Reasons Why Forecasting Must Replace Predicting and How to Make the Strategic Change in Business and Public Policy (New York; CRC Press, 2014). This book draws significantly on atmospheric physics and weather forecasting, the fields I studied before becoming an economist.

3. To the best of my knowledge, the only book on economic statistics that addresses the fundamental importance of data quality is Bauer, JC, Statistical Analysis for Decision-Makers in Health Care; Understanding and Evaluating Critical Information in Changing Times (New York: CRC Press, 2009).

4. RJ Samuleson, “Economists often don’t know what they are talking about.” Washington Post, May 12, 2019; https://www.washingtonpost.com/opinions/economists-often-dont-know-what-theyre-talking-about/2019/05/12/f91517d4-7338-11e9-9eb4-0828f5389013_story.html?utm_term=.7c1921587cd1